In the meta‐analysis by Ye et al. that included 10 studies, IVUS guidance was associated with a reduction in all‐cause mortality (RR = 0.60, p < 0.001), cardiac mortality (RR = 0.47, p < 0.001), myocardial infarction (RR = 0.80, p = 0.12), and stent thrombosis (RR = 0.28, p = 0.004). In the meta‐analysis by Wang et al. that included seven studies (only some of which were included in the Ye meta‐analysis), IVUS guidance was associated with a reduction in all‐cause mortality (RR= 0.55, p < 0.001), cardiac mortality (RR= 0.45, p<0.001), myocardial infarction (RR=0.66, p <0.001), and stent thrombosis (RR=0.48, p=0.001) [46].
Special imaging cases
IVUS provides the potential for reduced contrast volume with an upfront low contrast IVUS‐guided strategy as demonstrated in recent studies zero‐contrast IVUSguided PCI. [56,57]. Efforts are underway to develop noncontrast‐based flush media alternatives for optical coherence tomography (OCT) [58]. IVUS is also important for PCI for chronic total occlusion intervention (see relevant chapter); identifying and crossing the proximal fibrous cap, determining whether the wire and IVUS catheter are in the true or false lumen proximally and distally before stenting to avoid implanting a stent into a false lumen, guiding stent optimization, and assessing complications. IVUS is also the preferred modality to visualize the true lumen especially after guidewire crossing because it avoids hydraulic forces that occur with forceful injection of flush media (i.e. risk to widen the flap if wiring went in the false lumen) with either angiography or OCT.
Conclusions
Grayscale IVUS provides (i) high quality, tomographic imaging of the lumen, the atheroma, and the vessel wall, (ii) incremental and more detailed qualitative and quantitative information than coronary angiography, (iii) practical guidance for percutaneous coronary intervention, and (iv) many clinical and research insights. IVUS has become an important part of DES studies, representing an effective way to understand the mechanisms, effects, and complications of stent technology. PCI optimization with IVUS after stent implantation has been associated with a reduction in death as well as other hard end points of myocardial infarction and stent thrombosis. Development of high‐definition IVUS, hybrid IVUS‐OCT imaging or integration of novel techniques, including IVUS and near‐infrared spectroscopy may represent the next intracoronary imaging frontier.
Interactive multiple choice questions are available for this chapter on www.wiley.com/go/dangas/cardiology
References
1 1 Bom N, Lancee CT, Honkoop J, Hugenholtz PG. Ultrasonic viewer for crosss sectional analyses of moving cardiac structures. Biomed Eng 1971; 6(11): 500–503, 505. PubMed PMID: 5133281.
2 2 Bom N, Lancee CT, Van Egmond FC. An ultrasonic intracardiac scanner. Ultrasonics 1972; 10(2): 72–76. PubMed PMID: 5017589.
3 3 Yock PG, Linker DT, Angelsen BA. Two‐dimensional intravascular ultrasound: technical development and initial clinical experience. J Am Soc Echocardiogr 1989; 2(4): 296–304. PubMed PMID: 2697308.
4 4 Räber L, Mintz GS, Koskinas KC, et al. ESC Scientific Document Group. Clinical use of intracoronary imaging. Part 1: guidance and optimization of coronary interventions. An expert consensus document of the European Association of Percutaneous Cardiovascular Interventions. Eur Heart J. 2018 Sep 14; 39(35):3281–3300. doi: 10.1093/eurheartj/ehy285. Erratum in: Eur Heart J. 2019 Jan 14; 40(3):308. PMID: 29790954.]
5 5 [Johnson TW, Räber L, di Mario C, et a. lClinical use of intracoronary imaging. Part 2: acute coronary syndromes, ambiguous coronary angiography findings, and guiding interventional decision‐making: an expert consensus document of the European Association of Percutaneous Cardiovascular Interventions. Eur Heart J. 2019 Aug 14; 40(31):2566–2584. doi: 10.1093/eurheartj/ehz332. PMID: 31112213.]
6 6 Mintz G. Intracoronary Ultrasound. Taylor & Francis, Abingdon, UK:2005.
7 7 Siegel RJ, Chae JS, Maurer G, et al. Histopathologic correlation of the three‐layered intravascular ultrasound appearance of normal adult human muscular arteries. Am Heart J 1993; 126(4): 872–878. PubMed PMID: 8213444.
8 8 Nishimura RA, Edwards WD, Warnes CA, et al. Intravascular ultrasound imaging: in vitro validation and pathologic correlation. J Am Coll Cardiol 1990; 16(1): 145–154. PubMed PMID: 2193046.
9 9 Velican D, Velican C. Comparative study on age‐related changes and atherosclerotic involvement of the coronary arteries of male and female subjects up to 40 years of age. Atherosclerosis 1981; 38(1‐2): 39–50. PubMed PMID: 7470204.
10 10 Isner JM, Donaldson RF, Fortin AH, et al. Attenuation of the media of coronary arteries in advanced atherosclerosis. Am J Cardiol 1986; 58(10): 937–939. PubMed PMID: 3776849.
11 11 Mintz GS, Painter JA, Pichard AD, et al. Atherosclerosis in angiographically “normal” coronary artery reference segments: an intravascular ultrasound study with clinical correlations. J Am Coll Cardiol 1995; 25(7): 1479–1485. PubMed PMID: 7759694.
12 12 Glagov S, Weisenberg E, Zarins CK, et al. Compensatory enlargement of human atherosclerotic coronary arteries. N Engl J Med 1987; 316(22): 1371–1375. PubMed PMID: 3574413.
13 13 Losordo DW, Rosenfield K, Kaufman J, et al. Focal compensatory enlargement of human arteries in response to progressive atherosclerosis: in vivo documentation using intravascular ultrasound. Circulation 1994; 89(6): 2570–2577. PubMed PMID: 8205666.
14 14 Mintz GS, Kent KM, Pichard AD, et al. Contribution of inadequate arterial remodeling to the development of focal coronary artery stenoses: an intravascular ultrasound study. Circulation 1997; 95(7): 1791–1798. PubMed PMID: 9107165.
15 15 Schoenhagen P, Ziada KM, Kapadia SR, et al. Extent and direction of arterial remodeling in stable versus unstable coronary syndromes: an intravascular ultrasound study. Circulation 2000; 101(6): 598–603. PubMed PMID: 10673250.
16 16 Inaba S, Mintz GS, Farhat NZ, et al. Impact of positive and negative lesion site remodeling on clinical outcomes: insights from PROSPECT. JACC Cardiovasc Imaging 2014; 7(1): 70–78. PubMed PMID: 24433710.
17 17 Wu X, Mintz GS, Xu K, et al. The relationship between attenuated plaque identified by intravascular ultrasound and no‐reflow after stenting in acute myocardial infarction: the HORIZONS‐AMI (Harmonizing Outcomes With Revascularization and Stents in Acute Myocardial Infarction) trial. JACC Cardiovasc Interv 2011; 4(5): 495–502. PubMed PMID: 21596321.
18 18 Lee SY, Mintz GS, Kim SY, et al. Attenuated plaque detected by intravascular ultrasound: clinical, angiographic, and morphologic features and post‐percutaneous coronary intervention complications in patients with acute coronary syndromes. JACC Cardiovasc Interv 2009; 2(1): 65–72. PubMed PMID: 19463400.
19 19 Pu J, Mintz GS, Biro S, et al. Insights into echo‐attenuated plaques, echolucent plaques, and plaques with spotty calcification: novel findings from comparisons among intravascular ultrasound, near‐infrared spectroscopy, and pathological histology in 2,294 human coronary artery segments. J Am Coll Cardiol 2014; 63(21): 2220–2233. PubMed PMID: 24681142.
20 20 Shiono Y, Kubo T, Tanaka A, et al. Impact of attenuated plaque as detected by intravascular ultrasound on the occurrence of microvascular obstruction after percutaneous coronary intervention in patients with ST‐segment elevation myocardial infarction. JACC Cardiovasc Interv 2013; 6(8): 847–853. PubMed PMID: 23871509.
21 21 Xu K, Mintz GS, Kubo T, et al. Long‐term follow‐up of attenuated plaques in
